Reimbursement Team Lead

Position Title: Reimbursement Team Lead
Department: Reimbursement
Reports To: Head of Reimbursement
Job Type: Full Time
Shift: Monday - Friday 08:30 AM - 05:00 PM
Exempt / Non-Exempt: Non Exempt

Purpose

The Reimbursement Team Lead is responsible for overseeing and managing the reimbursement processes and team members within an organization.

 

Responsibilities

  • Effectively track and assist recording of the On Boarding forms for the signed providers
  • Maintain Master OB Tracker
  • Communicate any changes to providers, resend, edit and email necessary documents each quarter with changes
  • Report and track Medicaid Fee Schedules by state for Extremity Care products
  • Assist IVR team as needed on prior authorization follow up
  • Research the “pending auth” cases to document if process was followed for reimbursement
  • Assist in developing and writing process and procedure manuals for department
  • Research and respond to unusual or complex reimbursement scenarios assisting in appeals processes and requirements
  • Assist providers with understanding of EC billing guides and the claim process
  • Assist with daily distributor emails and provider inquiries
  • Experience with payer websites, electronic clearinghouses, Availity
  • Special projects, as assigned
  • Maintain a working knowledge of FDA 21 CFR 1271, FDA 21 CFR 820, AATB standards, ISO Standards, cGMP/CGTP, other relevant regulations/standards, and internal organizational policies and standard operating procedures.
  • Manage direct reports.
  • Provide constructive feedback and guidance to develop leadership in direct reports and department management.
  • Establish and monitor objective annual goals for direct reports.
  • Conduct performance reviews and establish performance improvement plans as needed.
  • Recruit, interview, and select personnel for hire.
  • Maintain acceptable attendance and punctuality for scheduled work hours and meetings. Ensure completion of assigned tasks and responsibilities within defined timeframes.
  • Flexibility to work outside of normal business hours during weekdays or weekends with reasonable advance notice to support business/operational needs when necessary.
  • Perform other duties as assigned.

 

Skills

  • Ability to interpret medical benefits, EOBs, appeal letter responses from payers
  • Must have attentive to detail, accuracy and must possess organizational skills
  • Excellent communication and documentation skills required
  • Ability to discuss claim issues with providers, medical staff, and sales personnel
  • Solid understanding of Medicare LCDs and commercial medical policies
  • Knowledge of CPT, HCPCS, and ICD10 coding and medical terminology
  • Ability to work independently and in a team environment
  •  Excellent attention to detail and organization
  • Excellent written and verbal communication
  • Highest level of ethics and integrity
  • Ability to lead and motivate the right behaviors
  • Ability to multi-task and work in a fast-paced environment
  • Strong technical writing
  • Effective project management
  • Proficiency in Microsoft Office

 

Qualifications/Requirements

  • Bachelor’s degree in business or related field, from an accredited college or university required.
  • At least 3 year(s) of experience in medical billing, reimbursement, revenue cycle management or related field required.
  • Associate’s degree (or 60 credit hours) may be substituted to meet up to 2 years of experience requirements.
  • Bachelor’s degree may be substituted to meet up to 4 years of experience requirements.
  • Master’s degree may be substituted to meet up to 6 years of experience requirements.
  • Clearance of favorable background investigation required.